To your health

Peter Hajek writes:

Electronic cigarettes (EC) are a consumer product appealing to smokers looking for a safer way to obtain what they want from their cigarettes. From what we know about EC ingredients, toxicology and the chemical and physical processes involved, they can be expected, outside pregnancy, to be at least 95% less harmful than cigarettes [1]. There is now a sufficient body of evidence available on several aspects and effects of EC for recent reviews to conclude that health care professionals and public health bodies should encourage smokers who cannot stop smoking using available treatments, or do not want to do so, to switch to EC [2],[3].

Yet at the same time, the World Health Organisation (WHO) have labelled EC a threat to public health, issued a strong advice to smokers not to use them [4], and urges policy makers to limit their use by prohibition or strict regulation [5]. This and other negative campaigns are starting to have an alarming effect of persuading smokers that EC are as harmful as cigarettes [6] and discouraging them from making the switch [7],[8].

This commentary argues that EC have a potential to generate substantial public health benefits and that discouraging smokers from using them and regulating EC as severely as cigarettes, or even more severely, is detrimental to public health.

Today’s e-cigarettes appeal to only a fraction of the smoking population, but if they are allowed to carry on competing with cigarettes as a consumer product and innovate and evolve, there is a good chance that they will continue to improve in offering smokers what they want, cigarette sales will continue to fall, and over the next 10 years, in countries where EC are available and competitively priced, the use of combustible tobacco will virtually disappear. The public health benefit would be huge, even if recreational use of nicotine carries on. If, on the other hand, misleading public health messages discourage smokers from switching and drastic regulations stop EC evolution and make them uncompetitive, the opportunity for a dramatic reduction in smoking related disease and death will be postponed by many years or even missed altogether. Future commentators are likely to consider attempts to remove safer alternatives to cigarettes from the market unethical, however virtuous the missionaries of the nicotine eradication gospel may feel. In the meantime, clinicians facing smokers who cannot or do not want to stop smoking and who follow evidence and common sense rather than ideologically and commercially driven agendas should recommend that their patients try several types of e-cigarettes to see if they can find one meeting their needs.

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